The Surgeon General of the United States has a prescription for making Americans healthy and fit that can be summarized in two words—LOSE WEIGHT.

Whether Dr. Benjamin’s vision of adults eating healthy foods and getting at least 150 minutes of moderate-intensity physical activity each week can become a reality remains to be seen. But no one will dispute the need for change. Currently, 2 out of 3 U.S. adults and 1 out of 3 U.S. children are either overweight or obese. Among women 40 to 59 years of age, 52% of non-Hispanic blacks and 47% of Hispanics are obese, compared to 36% of non-Hispanic whites. Even among teenagers the obesity rate for non-Hispanic blacks (29%) is twice that of non-Hispanic whites (14.5%).

To make matters worse, individuals who are overweight or obese are more likely to suffer from chronic diseases such as heart disease, type 2 diabetes, high blood pressure, and high cholesterol and the complications that accompany those diseases. For example, since 1980, the number of Americans with type 2 diabetes has tripled.

While genes, metabolism, environment, and culture influence body weight, too many calories and too little physical activity are the primary causes of obesity. The Surgeon General’s solution is simple—exercise more and eat less with an emphasis on the ‘eat less’ because the fact is you can out eat any exercise program.

Perhaps Andrew Wakefield, MD didn’t realize that his 1998 study erroneously linking vaccinations to autism would ignite a decade long controversy. But he should have. If not for the media frenzy fomented by high profile celebrities, the scientific method might have triumphed long ago. Journalists should know better. Yet given the scope of the damage, any claim of vindication would ring hollow. In the end, science prevailed, but at what cost?

After the United Kingdom General Medical Council (GMC) described the actions of Andrew Wakefield, MD, and two of his colleagues as dishonest and irresponsible, The Lancet, a respected medical journal, did something it has only done 10-15 times in its 186-year history, it fully retracted a study by Wakefield and colleagues from the published record.

In 1998, claiming to have found a possible link between autism and the measles-mumps-rubella (MMR) vaccine, Andrew Wakefield and 13 co-authors ignited a firestorm of controversy. Parents fearing that their children would become autistic, refused to have them vaccinated. Lawyers eager to place blame, filed class action lawsuits. Both sides launched personal attacks.

Too little too late
Five years later, ten of the 13 co-authors disavowed the findings. Last year the U.S. vaccine court ruled against those claiming that there was a link between vaccines and autism. Countless research dollars have been spent on rigorous studies aimed at refuting Wakefield’s findings. Fears over a reemergence of diseases like polio and measles should children go unvaccinated are being realized. And most important, the rate of autism has continued to climb.

The California Department of Developmental Services analyzed data on childhood autism from 1995-2006. The rate of autism at age 3 for children born in 1993 was 0.3 per 1000 births; among children born ten years later the rate was 1.3 per 1000 births; by 2006, 4.5 out of every 1000 children born in 2000 were estimated to have autism.

In an effort to help our readers better understand the controversy surrounding vaccines and autism, excerpts from an article previously published in Feeding Times, a baby gooroo publication follows.

The history behind the controversy
Arthur Allen was one of the first to write about the thimerosal controversy in an August 2002 report published in New York Times Magazine. Allen’s report was followed in June 2005, by a series of articles by Robert Kennedy, Jr. in Rolling Stone and Salon.com, in which Kennedy accused government scientists and their academic colleagues of covering up indisputable evidence of a causal link between thimerosal and autism. That same year, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic, A Medical Controversy by David Kirby was released. One critic described Kirby as “an author subtly influenced by the vaccine paranoia people” and cautioned readers to “beware of books like these because they lead with fear and not knowledge.”

Arthur Allen, in response to the Rolling Stone article by Kennedy stated, “Aside from a June 25 New York Times article that discussed the parallel realities of parents and scientists studying thimerosal, there has been little mainstream media response. Considering that about 9,000 lawsuits of claims have been filed against thimerosal and have the potential to wreck the pharmaceutical industry, the debate has high stakes.”

What is thimersol?
Thimerosal is an organic compound that contains ethyl mercury. It has been used in vaccines since the 1930s to prevent bacterial and fungal contamination. Thimerosal extends the life of vaccines and allows them to be packaged in multi-dose vials.

Is thimerosal safe?
Thimerosal contains mercury, a toxic metal. Mercury occurs naturally in the environment (air, soil, water). It has been found in fish (particularly long-lived fish such as sharks, tilefish, king mackerel, and swordfish) and in small amounts in animal tissues (humans). Dental fillings often contained Mercury, as did thermometers, and vaccines. If large amounts of mercury accumulate in the body over time, death can occur. The Environmental Protection Agency (EPA) has established tolerance levels for mercury based on studies of methyl mercury. The EPA tolerance level is ten times less than the lowest level calculated to cause harm.

Mercury exists in several forms: metallic mercury, inorganic mercury, and organic mercury (methyl mercury, ethyl mercury, phenyl mercury). Thimerosal contains the organic mercury known as ethyl mercury. Nearly all of the research done on mercury toxicity has focused on the organic methyl mercury. Methyl mercury and ethyl mercury are closely related but they have important differences. Different forms of mercury have different health effects. Methyl mercury has a half life of 50 days and accumulates in the body. Ethyl mercury has a half-life of 7-10 days and is less likely to accumulate in the body. Also, ethyl mercury is converted in the body into inorganic mercury and excreted in the stool.

In 1999, the U.S. Food and Drug Administration (FDA) determined that children receiving all of the routinely recommended childhood vaccines would potentially exceed the Environmental Protection Agency (EPA) tolerance levels for mercury (levels based on studies of methyl mercury). So in the interest of safety and out of concern that misinformation regarding thimerosal would lead to widespread refusal of vaccines, the FDA asked vaccine manufacturers to eliminate or reduce the mercury content of vaccines.

Since 2003, all routinely recommended childhood vaccines have been thimerosal-free. Only one childhood vaccine still contains trace amounts of thimerosal (influenza vaccine). Because thimerosal-containing vaccines produce levels of mercury in adults that are so low, experts do not recommend removal of thimerosal from vaccines intended for use in adults and adolescents.

Manufacturers now bottle vaccines in single-dose containers taking care to ensure that the vaccines are not contaminated in the manufacturing and bottling process. This has increased the cost of vaccines and led to vaccine shortages. However, despite these concerns, public health officials are committed to providing thimerosal-free vaccines.

What is autism?
Autism Spectrum Disorders are a group of developmental disabilities that are caused by an abnormality in the brain. According to the Centers for Disease Control and Prevention (CDC), 2/1000 to 6/1000 children have an Autism Spectrum Disorder (ASD). ASDs range from a severe form, autistic disorder (classic autism) to a mild form, Asperger syndrome. If a child has symptoms of either disorder but does not meet the specific criteria of either, he/she is diagnosed with pervasive developmental disorder not otherwise specified (PPD-NOS).

Classic autism affects verbal and nonverbal communication and social interaction. It is usually evident before age three, and can negatively affects educational performance. Characteristics of autism include irregularities and impairments in communication, engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

What causes autism?
Genetics is thought to play a key role in the development of autism. Using a broad definition of autism, when one twin has autism, approximately 92% of identical and 10% of fraternal twins have autism, suggesting that autism has a genetic component.

Home movie studies provide some of the best data on when symptoms of autism first appear. In one particular study, home movies were taken of children who eventually were diagnosed with autism and children who were not diagnosed with autism. The movies were made before the children received the MMR vaccine. Neurodevelopment specialists viewed the movies and were consistently able to separate autistic from non-autistic children at one year of age. Using sophisticated movement analysis, movies of children eventually diagnosed with autism and children not diagnosed with autism were coded and evaluated for their capacity to predict autism. Children who were eventually diagnosed with autism were predicted from movies taken at 2-3 months of age. These data clearly show that subtle symptoms of autism are present in early infancy and argue against vaccines as a cause of autism.

Some evidence suggests that autism occurs as a result of in utero events such as viral infection. Children exposed to thalidomide during the first or early second trimester were found to have an increased incidence of autism. Autism has been observed in children with ear, but not arm or leg abnormalities. Because arms and legs develop after 24 days’ gestation, it was concluded that the risk period for autism following receipt of thalidomide must be before 24 days’ gestation.

Researchers have also reported an increased risk for autism in children with congenital rubella syndrome and tuberous sclerosis, suggesting that autism involves abnormalities of the central nervous system that occur in utero.

Do vaccines cause autism?
The controversy surrounding vaccines and autism dates back to 1998 with the publication of the now retracted paper by Andrew Wakefield titled, “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” The authors theorized that the measles-mumps-rubella (MMR) vaccine causes a series of events that result in the development of autism. The study describes 12 children with neurodevelopmental delay (8 with autism). The author notes that each of the 8 autistic children was diagnosed with autism within 1 month of receiving the MMR vaccine.

Significant flaws found in study
Critics argued that the MMR vaccine is administered to nearly all children at a time when many children are diagnosed with autism. Therefore the observation that some children with autism recently received the MMR vaccine is expected. In addition, only vaccinated children were included in the Wakefield study. To determine whether the MMR vaccine causes autism, both vaccinated and unvaccinated children must be studied. Furthermore, in each of the 8 autistic children, symptoms of autism were observed before, not after, the presence of gastrointestinal symptoms, thus refuting the authors’ claim that autism is a consequence of gastrointestinal inflammation. Wakefield published a second paper in 2002, in which he examined the relationship between the measles virus and autism. Again critics cited a number of flaws.

While the two studies by Wakefield suggest a causal link between the MMR vaccine and autism, five additional studies conclude the opposite. Researchers found no difference in the age of diagnosis of autism in vaccinated and unvaccinated children; the onset of regressive symptoms of autism did not occur within 2, 4, or 6 months of receiving the MMR vaccine; and despite a dramatic increase in the number of reported cases of autism, the percentage of children that have received the MMR vaccine has remained the same. Data from a Danish study show that rates of autism continued to rise despite the removal of thimerosal from all vaccines in 1992.

The result of a critical review of the data was also published in Pediatrics in 2004. Twelve publications met the selection criteria, 10 epidemiologic studies and 2 pharmacokinetic studies. The authors concluded that the data did not support the claim that thimerosal-containing vaccines cause autism.

No link between thimerosal-containing vaccines and autism
In 2000, in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), the Institute of Medicine (IOM) established an independent expert committee to evaluate the data and determine whether vaccines cause specific health problems.

The Immunization Safety Review Committee published a series of reports between 2001 and 2004. The committee concluded that neither thimerosal-containing vaccines nor the MMR vaccine is associated with autism.

A second IOM committee met in February 2005, composed of different scientists. According to Committee Chair John C. Bailar III, “concerns about access and transparency have accompanied the development and functioning of the Vaccine Safety Datalink data-sharing program, and consequently some people’s trust in the reliability of findings from VSD studies has eroded. Taking steps to improve the independence, transparency, and fairness of VSD procedures will help enhance confidence in the data sharing program and in research based on this important tool for evaluating vaccine safety.”

The Vaccine Safety Datalink is a large, linked database of patient information that was developed jointly by CDC and several private managed care organizations in 1991. It includes data on vaccination histories, health outcomes, and characteristics of more than 7 million patients from eight participating health organizations. Researchers from the CDC and the managed care groups have used VSD information to study whether health problems are associated with vaccinations. The subsequent VSD data-sharing program was launched in 2002 to allow independent, external researchers access to information in the database.

Are vaccines safe?
Vaccines have significantly reduced, and in some cases eliminated, many childhood diseases. In the past, polio, rubella, measles, diphtheria, tetanus, chickenpox, and pertussis (whooping cough) were among the diseases that caused thousands of deaths each year. Today, as a result of immunizations, these diseases rarely occur. A widespread decline in immunizations would lead to outbreaks of serious diseases that now occur rarely.

Any discussion of vaccine safety must include a discussion of the benefits of immunizations as well as the risks. All vaccines have possible side effects. Most side effects are mild and include fever, rash, and tenderness or swelling at the injection site. Some side effects can be severe. For example, the pertussis vaccine can cause persistent crying, high fever, and seizures. While these side effects seldom cause permanent damage, they can be frightening for parents. But if you compare the potential risks of vaccines and the established risks of disease, vaccines, with few exceptions, are the safer choice for both children and adults.

What parents and need to know
• Few things in medicine work 100% of the time.

• Few things in medicine are risk-free.

• Researchers are working continually to improve the safety of immunizations.

• A decline in immunization rates will lead to an increase in disease.

To illustrate this fact: In 1974, when 80 percent of Japanese children were vaccinated for pertussis (whooping cough), only 393 cases of pertussis occurred and none of the victims died. The following year information was circulated that the pertussis vaccine was no longer needed and that is was unsafe. By 1976 only 10 percent of Japanese infants were vaccinated and in 1979 over 13,000 cases of whooping cough were reported along with 41 deaths. These are the risk/benefit ratios that parents as well as professionals must consider.

• The only time it is safe to stop giving immunizations is when a disease has been eradicated worldwide.

Only a parent of an autistic child can fully understand the anguish that comes from not knowing autism’s cause. But no amount of fear or frustration justify an abandonment of science.

Bibliography for reference

1. Dales L, et al. Time trends in autism and in MMR immunization coverage in California. JAMA 2001;285:1183-1185.

2. Kaye JA, del Mar Melero-Montes M, Jick H. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ 2001;322(7284):460-3.

3. Madsen KM, Hviid A, Vestergaard M, Schendel D, Wohlfahrt J, Thorsen P, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Eng J Med 2002;347(19):1477-82.

4. Mars AE, Mauk JE, Dowrick PW. Symptoms of pervasive developmental disorders as observed in prediagnostic home videos of infants and toddlers. J Pediatr 1998;132(3 Pt 1):500-4.

5. Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics 2004;114(3):793-804.

6. Stromland K, et al. Autism in thalidomide embropathy: a population study. Devel Med Child Neurol 1994;36:351-356.

7. Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J. Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study. BMJ 2002;324(7334):393-6.

8. Taylor B, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet 1999;353:2026-2029.

9. Uhlmann V, et al. Potential viral pathogenic mechanism for new variant inflammatory bowel disease. Journal of Clinical Pathology: Molecular Pathology 2002;55:1-6.

10. Wakefield AJ, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998;351:637-641.

The expression, “You are what you eat,” takes on new meaning, given the results of a recent study linking soy formula in babies with uterine fibroids in adults. Uterine fibroids are non-cancerous tumors of the uterus that commonly cause pelvic pain, vaginal bleeding, and fertility problems. Approximately one-fourth of women develop uterine fibroids which are the leading cause of hysterectomy (removal of the uterus).

Method
Twenty thousand white women between 35 and 59 years of age participated in the study. The women were selected from a larger group of 50,000 white women who are part of the Sister Study, a long-term review of women ages 35-74 who have never had breast cancer themselves but whose biological sister was diagnosed with the disease.

Women were asked whether they had ever been diagnosed with uterine fibroids and their age at diagnosis. They were also asked about a variety or early childhood exposures including whether they had been fed soy formula. Women were asked to choose from the following responses: definitely, probably, probably not, or definitely not fed soy formula.

Results
Women who were fed soy formula as babies were 25 percent more likely to develop uterine fibroids compared to those who were breastfed or fed cow milk formula. The link between uterine fibroids and soy formula is thought to be a response to the isoflavones (naturally occurring estrogen-like substances) in soy, and in particular, the high exposure at an early age in women given soy formula during infancy.

Although the American Academy of Pediatrics (AAP) recommends that babies be exclusively breastfed for the first six months of life, eight out of ten U.S. babies are given some type of artificial milk by three months of age. Soy formulas account for nearly 25% of the infant formula market. In 2008, the AAP’s Committee on Nutrition released a revised policy statement on the use of soy formula in infant feeding:

• Indications for use are rare and include metabolic disease or vegetarianism.

• Infants with documented cow milk allergy should be fed hydrolyzed formula, because 10-14% of these infants will also be allergic to soy.

• Once infants with severe diarrhea are rehydrated, they should be maintained on human milk or diluted cow milk formula.

• Soy formula has no advantage over cow milk formula as a supplement for the breastfed infant.

• Soy formula should not be fed to preterm infants.

• Use of soy formula does not alleviate colic or fussiness.

• Use of soy formula does not prevent allergic disease in high risk babies.

Bottom line
Concerns over the long-term health effects of soy formula are justified given that infants fed soy formula receive high levels of estrogen-like compounds relative to their body size. Until more data is available, parents are advised to follow the AAP policy and give soy formula only when medically indicated. If a baby is unable to breastfeed and human milk is not available, cow milk formula should be used.

Breastfeeding keeps babies healthy, but breastfeeding can also make babies sick. The United States Agency for International Development (USAID) in 2008 estimated that 430,000 children under the age of 15 were newly infected with the human immunodeficiency virus (HIV). Most infections were transmitted from mother-to-child during pregnancy, labor, birth, or while breastfeeding. Estimates suggest that breastfeeding may account for one-third to one-half of all cases of mother-to-child-transmission (MTCT).

The Centers for Disease Control and Prevention (CDC) recommend that HIV-infected women in the United States not breastfeed. However, in countries where safe alternatives to human milk are scarce and the risk of infant death from illnesses other than AIDS is high, health authorities must balance breastfeeding’s benefits and risks.

Because the risk of mother-to-child transmission of HIV is relatively constant throughout the period of breastfeeding, and the risk of death in non-breastfed infants compared to breastfed infants declines with age, one strategy for balancing breastfeeding’s competing risks is to encourage mothers to breastfeed exclusively for 4 months then abruptly wean. In an effort to test this theory, researchers followed 749 children not infected with HIV but born to HIV-positive mothers for 24 months. The children were randomly assigned to two groups. One-half of the children were breastfed exclusively for 4 months and then abruptly weaned. The other half continued to breastfeed.

Results
Researchers found that the earlier a child is weaned, the greater that child’s risk for dying before the age of two. The mortality rate for children weaned at 4-5 months, 6-11 months, and 12-18 months was 2, 3, and 4 times greater than children breastfed longer than 18 months. Diarrhea was the leading cause of death, accounting for nearly 62% of the deaths in children 6-24 months of age.

Bottom line
The only reason to encourage early weaning is to reduce the risk for mother-to-child transmission of HIV. However, nothing is gained if the child remains free of HIV but dies from a disease longer breastfeeding could have prevented.

Stephanie Sanders and Alex Bligh both had trouble with their milk supply in their early weeks of breastfeeding. After trying everything else, both turned to a drug called domperidone and found their supply quickly increased. Both were able to continue breastfeeding their children.

The difference? Alex lives in Dunedin, New Zealand, where she got a prescription from her doctor and had it filled at the pharmacy. Stephanie lives in northeast Georgia and had to sneak around, ordering her supply from the internet—from a company in New Zealand. The pills subtly arrived in an unmarked box.

FDA: Not OK
Stephanie and other American women wanting to take domperidone must go to international outlets online because in 2004 the U.S. Food and Drug Administration issued a warning against the drug, effectively making it impossible to buy it in the U.S.

Domperidone is an antidopaminergic drug, which means it blocks dopamine receptors and helps suppress nausea and vomiting. Since prolactin is inhibited by dopamine, domperidone stimulates lactation and can boost the milk supply of mothers having trouble breastfeeding, though it’s generally seen as a last resort solution.

A new study conducted in Canada and published in the January issue of Pediatrics found that domperidone increased breast milk supply for women who gave birth prematurely, without altering the milk’s nutrient composition.

The American Academy of Pediatrics lists domperidone as a “maternal medication usually compatible with breastfeeding” and notes that there is no “reported sign or symptom in infant or effect on lactation” (other than increasing lactation, one would presume).

Developed by Belgian-based Janssen Pharmaceutica, which is part of Johnson & Johnson, domperidone is available by prescription in a handful of countries, including Canada, and over-the-counter in over a dozen other counties, including the U.K., Japan, and Switzerland.

So what’s the big deal?

In a 2004 conference call, the FDA listed five reasons for concern: a lack of approval for the specific indication of breastfeeding; the extent to which American women were using the drug; maternal safety risks; risks to the infant as the drug is excreted in breast milk; and risks associated with purchasing drugs online.

The FDA also mentions the specific risks of cardiac arrhythmias, cardiac arrest and sudden death, although those risks are associated with intravenous use of the drug, while breastfeeding mothers would take it orally. “Because of the possibility of serious adverse effects,” reads the transcript of the 2004 conference call, “The FDA recommends that breastfeeding women not use domperidone to increase milk production.”

The FDA reinforces its position on its MedWatch page. “The FDA took these actions because it has become aware that some women are purchasing this drug from compounding pharmacies and from foreign sources,” the statement reads. “Although domperidone is approved in several countries outside the U.S. to treat certain gastric disorders, it is not approved in any country, including the U.S., for enhancing breast milk production in lactating women and is also not approved in the U.S. for any indication.”

Protection or politics?
The response from the breastfeeding community was quick. Some domperidone supporters suggested the FDA was less concerned about safety and more interested in controlling imported drugs, as reported by The Washington Post.

At the time, prominent physicians released their own statements. “The FDA’s statement regarding domperidone is based on specious reasoning, bad science and their continued ignorance of the dangers of not strongly supporting breastfeeding,” said Jay Gordon, an American physician and International Board Certified Lactation Consultant. “Most experts agree that domperidone is not only safe and effective but is still legal in spite of the warning from the FDA.”

“The FDA has basically come up with a political statement,” said Jack Newman, a Canadian pediatrician and author. “They seem really ticked off because people were going around using a drug which they have not approved. The deaths (and I believe there were two) occurred with intravenous domperidone, which is never used anymore and has never been used for enhancing milk supply. It is likely that if this drug was given intravenously, that the patients were sick with other problems as well, a confounding variable. Furthermore, unlike what the FDA has led people to believe, perhaps unintentionally, these are not new cases, but two decades old…. I will continue to prescribe domperidone to women when I feel it will be useful. It’s a shame, though, for women in the U.S. to be deprived of this drug.”

From nightmare to success
Both Alex and Stephanie said they do not regret taking the drug. In Georgia, Sanders, the mother of two and a part-time speech therapist, had a difficult time nursing her older child, now 4 years. A blister on her nipple nearly became infected, and she had to temporarily breastfeed on only one side. Her body didn’t adjust as she had hoped, and she soon spent all her spare time pumping and taking fenugreek and blessed thistle (and supplementing with breast milk donated by a close friend who was nursing a baby the same age).

When her injured breast healed, she went back to breastfeeding on both sides, but still had trouble. Nothing seemed to work at all, but then—after a lot of research—she took domperidone. “I saw a pretty dramatic increase in two days,” she said. She took the drug from the time her son was 2 months old until he was 8 months old. “I’m relatively mainstream,” Sanders says. “I’m not incredibly rebellious against medical advice.”

But she knew she didn’t want to take Reglan, a trade name of metoclopramide, a legal drug that increases milk supply. Reglan crosses the blood-brain barrier (domperidone does not) and she knew some people “who had horrible experiences with Reglan and depression.” (Indeed, depression is listed as a rare side effect of Reglan.) She never told her pediatrician that she was taking domperidone, and while she planned to inform her own physicians if necessary, she never had an opportunity. “I felt completely confident the whole time I was taking it, not like I was doing anything wrong,” she says.

Meanwhile, in Dunedin, no one thought Alex was doing anything wrong; in fact, both her midwife and doctor recommended that she take the drug. The early days of breastfeeding were “basically a nightmare,” said Bligh, the mother of a 9-month-old daughter and part-time criminal and family lawyer. After watching her daughter lose substantial weight, pumping her breasts until she cried, addressing her daughter’s latch issues, finger-feeding and topping off with formula, she finally turned to domperidone.

“I was determined to breastfeed,” she says. ”It seemed to be the only option. It worked extremely well—definitely saw an increase after a couple of weeks, and I no longer had to top up with formula.” At the time, her daughter was 5 weeks old. For 6 months Alex took 9 pills a day, then dropped to 8, and after a few weeks of her baby eating solid foods, Alex dropped to just one pill a day, which she still takes.

She was initially worried about side effects but felt reassured after researching. “It was a last resort but a necessary one,” she says. “The only side effects that I could see were that I became a little dehydrated. I think the bonding and benefits that come with breastfeeding outweigh the risks that domperidone may pose.”

These may be only two isolated cases, but given that the Canadian study found a 267% increase in milk production among mothers taking domperidone compared to 18% in those taking a placebo, perhaps it’s time for the FDA to rethink its position. What could be more protectionist than providing mothers with safe access to an effective drug?

Long Chain polyunsaturated fatty acids (LCPUFAs) have generated considerable interest in recent years. Early animal studies suggested that low levels of  docosahexanoic acid (DHA) could interfere with brain development in unborn and newborn babies. However findings from studies with children were inconsistent. Whether enriched formulas offer long-term benefits remains unclear.

Research methods
Aiming to dispel the myth that docosahexaenoic acid (DHA) makes babies smarter, researchers from the United Kingdom (UK) followed 241 children from birth until four years of age. The children were divided into three groups: those that were breastfed, those that were fed DHA-fortified formulas, and those fed unfortified formulas. Researchers monitored feeding regimes and measured verbal abilities and attention span.

Study results
After controlling for mother’s IQ, education level, and social status and baby’s birth weight, the researchers found no relationship between babies’ DHA intake and children’s IQ.

“We do know that there are clear health benefits to breastfeeding but DHA, which is naturally present in breast milk and added to some formulas, is not the secret ingredient that will turn your child into an Einstein,” said Dr. Catharine Gale, lead researcher.

These results contradict earlier findings showing that not having DHA during critical time periods may lead to problems in brain development. While children in the DHA-enriched formula-fed group had higher verbal IQ scores compared to those fed unfortified formulas, the difference did not appear to be due to the DHA content of the formulas. The factors that most influenced brain development were the mothers’ intelligence and the level of mental stimulation the children received.

Bottom line
Parents should be advised to breastfeed, not because they want to make their babies smarter, but because breastfeeding is how babies are meant to be fed for reasons researchers have yet to discover.

Whenever my Dad came home from work to find my siblings and me glued to the television, he would call us a bunch of “vidiots,” turn off the TV, and usher us outside to run around until dark. For much of my childhood, TV was limited to one hour per night – with Saturday morning cartoons or a movie on the weekends if we were good – and that was it.

Although I find it slightly ironic that I am writing this on my laptop (equipped with high-speed wireless internet) while listening to a CD (through the TV, which is hooked up to my husband’s Play Station 3, of course), I am still sad to report that daily media usage in 8-18 year-olds has become more time-consuming than a full-time job. Add in texting and cell phone conversations, another 14 hours per week on average, and they become workaholics!

Many kids spend upwards of 50 hours each week watching TV, surfing the web, listening to music, or playing video games, while they spend less than 14 hours per week participating in sports or being physically active.

In a nationwide study released last week by the Kaiser Family Foundation, researchers found that current levels of media usage in 8-18 year-olds have increased significantly since 2004. Instead of 6 hours and 21 minutes of daily media usage in 2004, most kids now spend an average of 7 hours and 38 minutes using media for entertainment every single day (these totals do not include texting or talking on cell phones). Furthermore, when multi-tasking was included – surfing the web and listening to music simultaneously, for instance – the total daily exposure time increased from 8 hours and 33 minutes in 2004 to 10 hours and 45 minutes per day in 2009.

What Does This Mean for Parents?
Short of embracing a full-fledged Luddite worldview, how can parents take control of the amount of time their children spend using media for entertainment – and why should they?

For starters, as time in front of the TV or computer increases, grades decrease, according to the Kaiser study. Children who were heavy media users were also more likely to report often feeling unhappy or bored, and were less likely to get along well with their parents or be happy at school than moderate or light media users.

Parents should also know that the above numbers exclude computer and other media use for academic purposes, which can mean several additional hours of computer or media usage each week. It is almost hard to believe that children have any time to eat dinner, do homework, or help with household chores.!

The Kaiser study also reports that, parental limits and ground rules seem at least modestly successful at moderating the amount of time children spend using media. Parents looking for advice on monitoring or reducing their kids’ media time can also look to resources such as the National Institute on Media and the Family for tips on shifting the focus from computers and TV to family relationships and other, more engaging activities.

Why Has Media Use Increased?
Besides the fact that the domain of after-school gab sessions has switched from the living room to the chat room and group social games like Pogs and street hockey have given way to computer MMORPGs (massive multi-player online role-playing games), kids seem to be able to work media into every hour of the day.

Much of the overall increase in media usage over the past five years is likely attributable to increased access; few parental restrictions coupled with a rise in the number of children owning individual or portable media devices has created a window of opportunity for kids to cram even more media into their day than they could five years ago. In 2004, only 18% of 8 to 18 year-olds had an iPod or MP3 player, but by 2009 over 75% of them owned one.

To add to the accessibility theory, the Kaiser study showed that children with TV in their bedroom (the number of whom have cable or satellite TV growing 12% since 2004) have an average of four more hours per day of total media exposure than kids with no bedroom TV. Now that phones and music devices often have multiple media capabilities, kids can sneak a look at video clips on their iPods between classes or play Pac-man on their phones while waiting for the bus.

Although to some extent it could be argued that MP3 players have simply replaced portable CD players and that X-Box merely upstaged the neighborhood arcade, there is no doubt that kids are spending more time with the extensive range of modern media than ever before, leaving precious little time for anything else.

Now that I am old enough to set my own rules for media use, I am grateful that my parents restricted the time I could spend staring at the TV or the computer – it fostered my creativity, gave me a deeper appreciation of reading and board games, opened up my time for developing friendships, and ensured my involvement in many memorable household activities (including chores!). I understand that life has more to offer than pop culture and constant digital entertainment, and unless kids step back from the screen to find this out for themselves, that’s a lesson it may take a long time for them to learn.

Haiti needs a lot of things right now. But for some, nothing is more important or more needed than human milk.

The Human Milk Banking Association of North America (HMBANA), United States Breastfeeding Committee (USBC), International Lactation Consultant Association/United States Lactation Consultant Association (ILCA/USLCA), and La Leche League International (LLLI) are jointly issuing an urgent call for human milk donations for premature infants in Haiti, as well as sick and premature infants in the United States.

A press release announcing the need for milk noted that this week the first shipment of human milk from mothers in the United States will be shipped to the U.S. Navy Ship “Comfort,” which is stationed outside Haiti and set up with a neonatal intensive care unit and medical personnel to provide urgent care to victims of the earthquake. An International Board Certified Lactation Consultant and pediatric neonatologist are on board to aid the organizations in responding to requests to provide milk for both premature infants and at-risk mothers who have recently delivered babies on board the U.S.N.S. Comfort. Once milk supplies increase, donations will be made on the ground in Haiti.

Mothers who are willing to donate human milk should contact their regional Mothers’ Milk Bank of HMBANA. A list of regional milk banks is available on their website at www.hmbana.org or call 408-998-4550.

In an effort to encourage hospitals and birthing facilities to select exclusive breast milk feeding as one of their performance measures, the United States Breastfeeding Committee (USBC) recently published guidelines to aid hospitals and birthing facilities in collecting the data needed to ensure compliance.

baby gooroo previouslyaddressed the addition of “exclusive breast milk feeding” to the Joint Commission’s new Perinatal Care core measure set. The perinatal care measures are one of 10 sets of measurements which hospitals select from as part of The Joint Commission’s ORYX performance measurement initiative. Introduced in 1997, the ORYX initiative was designed to integrate outcomes and other performance measurement data into the accreditation process.

The Perinatal Care core measure set includes:

• Elective delivery

• Cesarean section

• Antenatal steroids

• Health care-associated bloodstream infections in newborns

• Exclusive breast milk feeding

The Joint Commission first began requiring accredited hospitals to collect data on standardized (core) performance measures in 2002. These standardized measures are designed to improve the quality of patient care by focusing on procedures and outcomes. Hospitals are required to collect and transmit data to The Joint Commission for a minimum of four voluntarily selected core measure sets or a combination of applicable core measure sets and non-core measures based on the patient population they serve.

This is a long fought victory for those who believe that exclusive breast milk feeding offers unique benefits compared to all other methods of infant feeding. Much of the data on the benefits of breastfeeding have been called into question due to the absence of a clear definition of breastfeeding in many of the studies. Now that The Joint Commission has defined exclusive breast milk feeding as, “a newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines,” data collected in hospitals and birthing centers can be pooled and analyzed. The Joint Commission also made it clear that breast milk feeding includes expressed mother’s milk as well as donor human milk, both of which may be fed to the infant by means other than suckling at the breast.

Now that the framework is in place, we can only hope that hospitals will give babies and breastfeeding the attention both deserve.

You grab a tub of ice cream off the grocery store shelf and survey the labels. Fat–15grams per serving. But how much of that is the good kind of fat (monounsaturated and polyunsaturated fats) and how much is bad (saturated and trans fats)? Unless you are a dietitian, deciphering nutrition labels is next to impossible.

Apparently sharing in the frustration, Congress has instructed the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to instruct the Institute of Medicine (IOM) to review nutrition rating systems found on the front of food packages and report its findings before the end of the year. Among the instructions to the IOM:

• Identify front-of-package systems currently in use by manufacturers, supermarkets, health organizations, and governments.

• Identify the purpose and overall merits of front-label nutrition icons.

• Identify the criteria underlying the systems and evaluate the science behind the systems.

• Identify advantages and disadvantages of each for adults and children.

• Develop conclusions about which system(s) are most effective in promoting health and how to maximize the use and effectiveness of the system(s).

• Consider the feasibility of a single, standardized front-of-package food nutrition rating system regulated by the Food and Drug Administration.

Driven by consumer demand for healthier, safer, and more environmentally friendly food products, the use of symbols, logos, and icons on the front of food labels to communicate nutritional information has become commonplace. This at times undecipherable informationis used to show not only the fat, sugar, salt, and calorie content, but whether the ingredients are genetically modified, organically grown, or cage-free. Happy-golucky hens? Not quite.

The point is, food labels need to be standardized and certifications need to be regulated and both need to be clearly communicated to consumers In the United Kingdom, the front of food packages is labeled with traffic lights. A red light means the food is high in a nutrient that should be eaten in small amounts, such as salt or sugar. A yellow light indicates that the food isn’t high or low in that nutrient, making it a better choice, albeit not the green choice. Green lights indicate the food is low in that nutrient. The more green lights, the healthier the choice.

Indicative of the controversy surrounding food labeling, the Smart Choices program was short-lived. A voluntary program supported by the nation’s largest food manufacturers, products approved by Smart Choices display a bright green check mark indicating that a particular food is a healthier choice than other foods in the same group. Only when the Smart Choices label appeared on sugared cereals and other foods considered less than nutritious did the FDA and the U.S. Department of Agriculture decide to monitor the effect of the program on consumer food choices. The Smart Choices board responded by suspending operations.

Surveys show that consumers base their food purchases on how healthy a product is or isn’t. However, the lack of a uniform rating system makes it difficult for consumers to compare foods and make not only healthier choices but healthy choices. This review by the IOM is an encouraging first step. Let’s hope it works. For the health of it.